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Test answers for Medical billing 2016

(80) Last updated: January 27
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80 Answered Test Questions:

1. A Remittance Advice statement is most similar to a(n):

Answers:

• EOB

• HMO extension

• Medigap

• Co-pay

2. True or False? A Medicaid MCO provides comprehensive services to Medicaid beneficiaries, but not commercial or Medicare enrollees.

Answers:

• False

• True

3. The exact abbreviation of RA in medical billing terminology?

Answers:

• Regular Appointment

• Rheumatoid Arthritis

• Right Atrium

• Remittance Advice

• Remote Agent

4. Is a co-payment an out of pocket expense?

Answers:

• Sometimes

• Yes

• No

5. The predetermined (flat) fee, a patient usually has to pay on each office visit is a:

Answers:

• Co-insurance

• Carrier

• Code

• Co-pay

6. What is Dx refer to?

Answers:

• Diagnosis code

• Post-mortem diagnosis

• Bill cancellation

• Cancelled diagnosis

7. What organ is measured in an EKG/ECG?

Answers:

• Kidney

• Heart

• Lung

• Brain

8. What is a premium?

Answers:

• The copay

• Name-brand medication

• Paying extra for a private hospital room

• The amount paid for an insurance policy

9. Which of these would be a valid reasons for a claim to be denied?

Answers:

• All are valid reasons

• The service was not covered under the patient’s health insurance contract.

• The service was considered as not being medically necessary

• The medical condition was deemed by the insurance company as being preexisting

10. What is COBRA insurance?

Answers:

• It is a slang term used to describe uninsured emergency room patients

• Insurance available to individuals after they become unemployed

• Insurance for exotic injuries

• It is an insurance plan specific to the military

11. A patient on an HMO plan typically needs a _________ to receive care from a specialist.

Answers:

• validation

• clearance

• prescription

• referral

12. The date the insurance policy is set to begin or when benefits or covered services are allowed is most commonly known as the:

Answers:

• Float date

• Effective date

• Startup date

• Coverage blanket date

13. True or false? Sometimes multiple treatments will fall under one billing code.

Answers:

• True

• False

14. Place of service codes on claims are there to define?

Answers:

• The place of service where services were rendered

• The type of service

• The time of service

• The payment qualifier

15. Which federal law strengthens the privacy of a patient's PHI and allows a patient to review their medical record?

Answers:

• HIPAA

• Medicare

• HEDIS

• COBRA

16. The amount paid, often in monthly installments, for an insurance policy by the employer or patient themselves, is the:

Answers:

• OOP

• Co-pay

• Deductible

• Premium

17. What does COB commonly refer to?

Answers:

• Course of Body

• Coordination of Benefits

• Cost of Billing

• Cost on Bottom

18. The federal law that allows a worker to continue to purchase employer paid health insurance for up to 18 months if they lose their job or your coverage is otherwise terminated is known as:

Answers:

• Medicaid

• NOSSCR

• HMO

• COBRA

19. What do the CPT codes refer to?

Answers:

• The disease that the patient is suffering from

• The procedures performed by a physician or a practitioner

• The names of the medicines prescribed by the practitioner

• The procedures performed by Medical biller

• The diagnoses performed on the patient

20. In medical billing, what is the function of a clearinghouse?

Answers:

• It calculates total patient bills

• It runs background checks on patient credit history

• It checks bills for errors then transmits them to the insurance company

• It processes all of the payments

21. True or False?  Tertiary insurance is intended to cover gaps in coverage the primary and secondary insurance may not cover.

Answers:

• True

• False

22. This health insurance coverage is available to an individual and their dependents after becoming unemployed - either due to voluntary or involuntary termination of employment for reasons other than gross misconduct.

Answers:

• GovCare

• Medicare Insurance

• Co - Insurance

• USICA

• COBRA Insurance

23. HIPAA stands for:

Answers:

• Health Insurance Portability Accountability Act

• Health Insurance Protected Act of America

24. ________ billing is when a patient is charged for the difference between what a doctor bills and what the provider and insurance company agree upon.

Answers:

• Downcoding

• Balanced

• Fair

• Upcoding

25. Which of these are NOT standard statuses of a claim in a typical EOB?

Answers:

• Denied

• Paid

• Pending

• Transition

26. Health Insurance Claim (HICN) is a number assigned by the Social Security Administration to an individual identifying him/her as a _______ beneficiary

Answers:

• Medicare

• CHIP

• COBRA

• Medicaid

27. In which month do commercial insurance and Medicare deductibles start each year?

Answers:

• March

• January

• June

• October

28. If a physician uses an open-panel HMO, can they see non-HMO patients?

Answers:

• No

• Yes

29. Hospital beds, wheelchairs and oxygen equipment would be considered examples of:

Answers:

• COBRA

• DOS

• EBSA

• DME

30. True or False? AWP laws are state laws that require health insurance companies to accept into their PPO and HMO networks any provider willing to agree to the insurance company's terms and conditions.

Answers:

• True

• False

31. A type of health coverage that typically allows a patient to go to any doctor or provider without permission is known as:

Answers:

• Contractor insurance

• Descriptor insurance

• On-call fees

• Fee-for-Service

32. What is capitation?

Answers:

• The hierarchy of payments

• A payment scheduling method

• A system that pays physicians and nurses a set amount per enrolled patient assigned to them

• The process of cutting down the price of a medical bill

33. When submitting a secondary claim, what is the name of the document that must be attached?

Answers:

• Certificate of codding

• Benefits of Explanation

• Explanation of Medical Necessity

• Explanation of Benefits

• Certificate of Medical Necessity

34. What is the purpose of an Advanced Beneficiary Notice?

Answers:

• To alert a patient that Medicare may deny payment for a specific procedure or treatment

• To alert a patient to a change in their premium payments

• To confirm receipt of a patient's payment

• To alert the hospital to changes in Medicare's coverage policies

35. Which of the following would you likely use if billing Medicare?

Answers:

• W-4

• UB-04

• HCFA1500

• UB-92

36. With the implementation of HIPAA, all the following systems became mandatory EXCEPT:

Answers:

• HCPCS

• ICD

• CPT

• ADT

37. Which part of Medicare is the drug prescription coverage?

Answers:

• Part A

• Part D

• Part B

• Part C

38. The Employer Identification Number is also known as the:

Answers:

• Social Security Identification Number

• Health Department Identification Number

• Employer Group Health Plan

• Federal Tax Identification Number

39. What is a clearing house?

Answers:

• Hygienic Place

• Payment clearing authority

• All of these

• None of these

• Intermediary between provider and insurance

40. True or False? ERISA includes PPOs, POS, and HMO benefit plans.

Answers:

• True

• False

41. An illegal practice of assigning an ICD-9 diagnosis code that does not agree with the patient records for the purpose of increasing the reimbursement from the insurance payor is called:

Answers:

• Code banking

• Upcoding

• Pocketlining

• ICD skimming

42. The ICD-9-CM coding classification to identify health care for reasons other than injury or illness is

Answers:

• V-code

• A-code

• H-code

• T-code

43. Which of the following is an agreement made between the insurance company and the insured to send payments directly to the physician?

Answers:

• Coordination of Benefits

• Assignment of Benefits

• Referral

• Preauthorization

• Pre-Existing Conditions

44. True or false? Undercoding is illegal.

Answers:

• FALSE

• True

45. Who is eligible for Medicare part C

Answers:

• An individual who has an HMO plan

• An individual who pays all premiums

• An individual who is covered under Parts A and B

• An individual who has a supplemental Plan

46. The form the provider uses to document the treatment and diagnosis for a patient visit which typically includes ICD-9 diagnosis and CPT procedural codes is the:

Answers:

• IPC-450 form

• Advanced payment form

• Superbill

• Focused item bill

47. Health insurance coverage which is contracted to supplement Medicare coverage is called:

Answers:

• Medigap

• SSDI

• HMO extension

• Medicaid

48. The HIPAA approved standard paper claim form submitted to insurance companies to have the outpatient health benefit or the contracted provider visit paid is the:

Answers:

• HIPAA 1450

• CMS 1500

• CMS 1450

• HIPAA 1500

49. Charging for services that are not medically necessary are included under:

Answers:

• Custodial care

• Low cost alternatives

• Abuse

• Information models

50. What does UCR stand for?

Answers:

• Unusual Chronic Illness

• Ultra Conservative Response

• Unique Client Referral

• Usual, customary, or reasonable

51. What could POS exactly stand for in Medical Billing?

Answers:

• Polycystic Ovary Syndorme

• Point of Service

• Place of Service

52. What are modifiers used for?

Answers:

• They are used to add more information about a ICD10 CM code

• They are used to add more information about a ICD-9 CM code

• They are an indicator to show that a procedure is linked to more than one diagnosis

• They help in establishing "medical necessity"

• They are used to add more information about a CPT code

53. True or False? The difference between the Medicare and Medicaid allowable is that Medicaid does NOT pay a percentage of the allowed amount.

Answers:

• True

• False

54. Level II HCPCS codes are formatted as a single letter followed by _________.

Answers:

• five numeric digits and one letter

• Four numeric digits

• Two numeric digits and 2 letters

• Two numeric digits and three letters

55. The claim form for  billing for facility fees which replaces the UB92 form is the _______ form.

Answers:

• UB100A

• CMS 1450

• UB04

• SNF20

56. True or false? The coder should NOT correct any errors in a bill.

Answers:

• TRUE

• False

57. How many digits are in a National Provider Identifier?

Answers:

• 8

• 9

• 10

• 4

• 11

58. Which one of the following was known as Medicare + Choice?

Answers:

• Part C

• Part D

• Part A

• Part B

59. The average amount Medicare will pay a provider or hospital for a procedure is the:

Answers:

• SNF

• CCRC

• PTAN

• RVU

60. Medical care, other than those provided by the physician or hospital, which are related to a patient’s care, are called:

Answers:

• Extraneous services

• All of these are correct

• Ancillary care

• Focused care

61. A 3-digit number used on hospital bills to tell the insurer where the patient was when they received treatment, or what type of item a patient received, is the:

Answers:

• SMI code

• Revenue Code

• Medical Code

• Policy identification number

62. Tricare was formerly known as

Answers:

• None of the above

• Civilian Health and Medical Program of the Uniformed Services(CHAMPUS)

• Humana Military Healthcare Services

• United States Department of Defense Military Health System

• Civilian Health and Medical Program of the United States(CHAMPUS)

63. Coding for a name-brand medication when a generic brand was used is called __________.

Answers:

• Upgrading

• Upcoding

• Swapping

• Value-coding

64. What is a challenge of processing medical bills off site?

Answers:

• It is illegal to process medical bills off site

• None of these

• The biller may not be able to contact the physician

• Governmental regulations

65. The difference between the summarized income rate and the summarized cost rate over a given valuation period is the:

Answers:

• Cost restraints

• Actuarial Balance

• Administrative discrepancy

• MediGap

66. Submitting several CPT treatment codes when only one code is necessary is called:

Answers:

• Abuse

• Fraud

• Facility charges

• Unbundling

67. A health benefit plan allowing the patient to choose to receive a service from a group of contracted providers is a:

Answers:

• PCP

• POS

• OOP

• PPT

68. The form which is specifically used to bill dental services is called?

Answers:

• HCFA 1500 form

• ADA form

• UB-04 form

• Dental Claim form

69. True or False? Med pay is a form of no-fault insurance.

Answers:

• True

• False

70. The federal law that was originally created to safeguard an employees retirement benefits is abbreviated as:

Answers:

• COBRA

• TRICARE

• ERISA

• NOSSCR

71. Will Medicare accept a UB-92 form?

Answers:

• No

• Yes

• Sometimes

72. What is the abbrevation for SSI?

Answers:

• None of the above

• Social Security Information

• Supplemental Security Income

• Social Security Income

• Supplemental Security Information

73. True or false? An individual on an HMO plan would need a referral to get a yearly mammogram.

Answers:

• TRUE

• False

74. Medicare Advantages Plans cover consultation codes?

Answers:

• Partially

• Yes

• No

75. Which one of the following is the largest Blue Cross Blue Shield member?

Answers:

• WellPoint

• CareFirst

• Highmark

• Premera

76. This type of workers compensation would be described as: abnormal conditions or disorders caused by exposure to enviromental factors. Examples of these could be exposure to a chemical, inhalation, ingestion or direct exposure.

Answers:

• Occupational illness

• Occupational Safety and Health Administration

• State Workers Compensation

• Federal Employment Liability Act

• Industrial accident

77. According to the MBAA, up to _____ % of US medical bills contain errors.

Answers:

• 35%

• 5%

• 50%

• 80%

78. A ________ limits the amount of out-of-pocket expenses a patient will have to pay for TRICARE-covered medical services.

Answers:

• TRICARE cap

• catastrophic cap

• Care ceiling

• HMO cap

79. If a provider is non-par, any allowed claim amount that is ______ billed charges should be unacceptable.

Answers:

• less than

• more than

• equal to

80. In DME claims which of the following is necessary: Referring physician or Ordering physician?

Answers:

• Referring Physician

• Both

• Neither

• Ordering Physician